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Federal forms, ICRs, and supporting documents

Information Collection

Application for Health Center Program Recipients for Deemed Public Health Service Employment with Liability Protections Under the Federal Tort Claims Act (FTCA)

IC 230498 under ICR 202203-0906-003 · OMB 0906-0035.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Redline
Other-Redline
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Application for Health Center Program Recipients for Deemed Public Health Service Employment with Liability Protections Under the Federal Tort Claims Act (FTCA)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 CY 2023 Health Center APPLICATION ONLY 3.2.22 CY 2023 Health Center APPLICATION ONLY 3.2.22.docx Yes Yes Fillable Fileable
Other-Redline Calendar Year 2023 Health Center Application Tracked Changes.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,160 0
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,160 0 0 0 0 1,160
Annual IC Time Burden (Hours) 2,900 0 0 0 0 2,900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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